1689731317 NPI number — SUFFOLK CHEST PHYSICIANS, LLP

Table of content: (NPI 1689731317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689731317 NPI number — SUFFOLK CHEST PHYSICIANS, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUFFOLK CHEST PHYSICIANS, LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689731317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
285 SILLS RD
Provider Second Line Business Mailing Address:
BUILDING 7, SUITE B
Provider Business Mailing Address City Name:
EAST PATCHOGUE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11772-4869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-654-4577
Provider Business Mailing Address Fax Number:
631-654-3391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
285 SILLS RD
Provider Second Line Business Practice Location Address:
BUILDING 7, SUITE B
Provider Business Practice Location Address City Name:
EAST PATCHOGUE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11772-4869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-654-4577
Provider Business Practice Location Address Fax Number:
631-654-3391
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MULRY
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
631-654-4577

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02556187 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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